Extremely rare form of central apnea. Central apnea is due to a disruption of the nerve impulses from the brain stem to the respiratory muscles.

There are different causes of central apnea:

• Cheynes-Stokes breathing: it is characterized by a gradual increase followed with decrease in breathing effort. A total lack of airflow (central sleep apnea) can occur during the weakest breathing effort periods.
• Central sleep apnea due a medical disorder without Cheyne-Stokes breathing :  patients with an underlying medical condition can develop central sleep apnea without the pattern of small and large breaths followed by long pause characteristic of Cheyne-Stokes breathing. This form of CSA is typically caused by damage to the brain stem through injury or disease (stroke, Parkinson’s disease) . It can also occur in case of chronic renal failure or heart failure
• Apnea of drug origin: e.g., morphine, which induces bradypnea and sometimes apnea
• Periodic breathing at high altitude (> 2500 m): alternation of hyperventilation and hypoventilation (> 2500m)
• Central apnea at the beginning of treatment of obstructive sleep apnea: some patients have central apnea at the beginning of the treatment of their obstructive apneas with CPAP
• Ondine syndrome: see this term
• Primary or idiopathic central apneas of childhood and adults: they are due to hypersensitivity of tthe chemoreceptors to PaCO2 which leads to alveolar hyperventilation. During sleep these patients have episodes of hyperventilation in the non-REM sleep phase: they lead to a decrease in PaCO2 below the apnea threshold and subsequent sleep respiratory disorders including central apnea.

Diagnosis: polysomnography.

Treatment: clinical trials with acetazolamide. Non-invasive ventilation with servo-controlled inspiratory support according to respiratory rate.

Anesthetic implications: 

contact the patient's sleep specialist; no interaction of anesthetic agents, including morphines, in a series of 47 interventions. Use the patient's ventilatory equipment post-operatively: a conventional CPAP can have deleterious effects

References : 

-         Aurora RN, Chowdhuri S, Ramar K et al.
The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses.
Sleep 2012; 35:17-40

-        Alexa A, Mansukhani MP, Gali B, Deljou A, Sprung J, Weingarten TN.
Primary central apnea and anesthesia: a retrospective case series. Can J Anesth 2018; 65:884-92.

Updated: October 2022